On October 11, 2012, the NRC issued a Notice of Violation to Benefis Hospitals for a violation of 10 CFR 35.41 associated with a Severity Level III violation involving the failure to have procedures that provide high confidence that each administration is in accordance with the written directive. Specifically, the licensee failed to have a written procedure for the specific treatment of esophageal cancer, which resulted in a high-dose rate afterloader administration of byproduct material and dose to a patient (nasopharyngeal dose in excess of 1000 centigray) that was not in accordance with the written directive.